The Cost of Success

For those of you who didn't know, I entered the National Novel Writing Month "contest" (which has no winners). I got to the goal of 50,000 words yesterday.
One of the main questions that is asked in my novel (which may or may not ever see the light of day) is this: What would happen if a wonderful cure came along that would take away most, if not all sickness? Remember, it is fiction.

The answer is, of course: utter chaos and collapse of our system.

Our system is designed to deal with sickness. It is designed to fix problems. If a wonder-drug came along, here's what I think would happen:

Pharmaceutical companies and hospitals would have to oppose it, as they would suffer financial ruin if people became healthy.

Doctors, especially those focused on chronic illness or treatment of serious problems, would take a huge cut in pay.

A huge number of healthy people would enter the workforce, disrupting an already fragile economy.

Human stupidity, of course, would remain. There would be some work for those in the medical profession, but only a fraction of what is there now.

I don't think anyone expects this "wonder drug" to appear any time soon, so what's the point of entertaining this scenario? Looking at the extremes can often give us insight to our current problems. One of our biggest problems is this: our system thrives on its own failure. If we fail to keep people well, the healthcare economy improves. There are more jobs to be had to treat and take care of these sick people. There is more need for new drugs to treat the increased number of sick people. Hospital beds are full, and doctors are busy.

Life is good for those of us in medicine when we fail.

I think this truth is not lost on some of those people who are cynical about traditional medicine. They see the motivation to keep people sick, and assume that there is a conspiracy afoot to accomplish this goal. Now, if there is a conspiracy, it doesn't include me. I do see success in keeping people healthier than if they didn't see me, and nobody has tried to bump me off yet. I'll let you know if they do.

But despite the fact that I don't see a conspiracy to make people sick, I do see a lack of a conspiracy to make people well. It's not an organized conspiracy; it's just a sin of omission. Success of our system, defined as people being kept healthy, comes at a huge cost. Why would people strive for success when the prize would be a pink slip?

Again, I am not saying that this is a conscious decision. I don't think there is a back-room deal between pharma, hospitals, and the government to prevent wellness. No, I just see a total lack of an organized effort to fix things. We are giving absolutely no motivation for success. There is nobody in the healthcare industry who truly benefits from health. If this is our goal (and I think it should be), shouldn't we somehow make it worth someone's while to keep people healthy?

Why aren't we setting goals to shut down hospitals, not keep them profitable? Why aren't we trying to motivate well care and prevention so that sick care and intervention will stop being so profitable? This can't be lost on those whose livelihood depends on the failure of the system. There will be great inertia to the sacred idea of treating the sick, and a reluctance to abandon it for the idea of eliminating the sick (through prevention, not euthanasia).

Would your kids clean their rooms if you docked their allowance for doing it? That's what we are doing. That's how our system is designed. We should not be surprised at failure when success comes at such a high cost.

Until things are changed at the most basic level, success in healthcare will be a purely fictional idea.